Provider Demographics
NPI:1194224485
Name:AGE IN PLACE WEST VIRGINIA L.L.C
Entity Type:Organization
Organization Name:AGE IN PLACE WEST VIRGINIA L.L.C
Other - Org Name:AGE IN PLACE WEST VIRGINIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF CARE-GIVING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MINERVA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN, DNS-CT,
Authorized Official - Phone:304-579-5853
Mailing Address - Street 1:101 MEDICAL CT STE 202
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-3854
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 MEDICAL CT STE 202
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3854
Practice Address - Country:US
Practice Address - Phone:304-579-5853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health